Remote Digital Microscopy Improves Hematology Laboratory Workflow by Reducing Peripheral Blood Smear Analysis Turnaround Time

Abstract

Background The demand for morphological diagnosis by peripheral blood smear (PBS) analysis with clearly defined turnaround times (TAT), coupled with a shortage of morphologists and increasing cost containment, is driving digitalization to the forefront of laboratory workflow. Labor-intensive manual PBS review affects weekend workflow with limited staff availability. The impact of remote analysis of PBS on the performance of hematology laboratories has not yet been assessed. Objectives Following implementation of fully remote digital microscopy within our laboratory, we measured its impact on morphology workflow efficiency, TAT and hours saved per month. Methods A retrospective study of the effects of remote PBS analysis on the morphology workflow in a tertiary medical center using the Scopio Labs X100 Full-Field PBS system was conducted. 10,704 PBS samples were analyzed pre-and post –implementation, over a five-month period. Overall PBS workload, and average TAT of PBS samples over weekends and the first two weekdays were collected and evaluated. Results Remote weekend viewing resulted in a 15.8% reduction in the overall morphology TAT of the lab (P<0.03) over a five-month period, despite similar overall workload. PBS analysis TAT on Fridays was reduced by 41.4% (P <0. 006), and by 59.1% on the first weekday (P<0.02). The additional hours incurred over the weekend were offset against a reduced need for double weekday shifts resulting in approximately 12.76 work hours saved per month. Internet links to clinically relevant cases are provided. Conclusions The Scopio Labs Full-Field X100 PBS system with remote analysis capacity significantly reduced PBS TAT and improved the morphology workflow of the hematology laboratory. PBSs with significant clinical findings are now available for remote viewing by on-call clinicians located outside the medical center perimeter. Remote PBS viewing, coupled with the overall monthly cost savings, merit consideration for the implementation of full digitalization for remote PBS review.

Digital assessment of peripheral blood and bone marrow aspirate smears

“…These full-field analyzers allow for remote analysis of PB smears and improved diagnostic turnaround time. 33 Web-based scanner-agnostic systems are also being developed to provide accurate WBC differentials across instruments. 34 Together, these improvements over current instrumentation for digital PB smear analysis will enhance diagnostic performance and will likely become integrated in the clinical laboratory over the next decade.…”

“…RBC morphology is performed manually, while PLT estimation is derived by automatically locating and counting platelets in 10 fields of view. These full‐field analyzers allow for remote analysis of PB smears and improved diagnostic turnaround time 33 . Web‐based scanner‐agnostic systems are also being developed to provide accurate WBC differentials across instruments 34 .…”

Digital morphology compared to the optical microscope: A validation study on reporting bone marrow aspirates

“…5,6 The development of software based on Artificial Intelligence has led to the diffusion of pre-classification systems of digitized images (DM) of peripheral blood (PB) hematological cells, favoring the intra-and inter-laboratory morphological diagnostic harmonization 7 by facilitating the vision and diffusion of cell images, dramatically reducing the time usually required for slide preparation, smear searching. Cell focusing procedures, field research and counting and archiving, reducing physical effort 8,9 and favoring harmonization and quality of the result are other potential advantages. 10 DM utilization for research, teaching and diagnostics is now a reality for the PB differential 11,12 while the development of the application on myelogram from bone marrow aspirate (BMA) is still in progress, [13][14][15][16] far from being included in the routine work.…”